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Manipulative Therapy in Rehabilitation of theLocomotor System, Third Edition
Journal of Manipulative and Physiological Therapeutics Volume 22 • Number 7 • September 1999 76/8/100392 • Book Reviews
BOOK REVIEWS
Manipulative Therapy in Rehabilitation of the Locomotor System, Third Edition. Karel Lewit, MD: Butterworth-Heinemann; 1999. 346 pages. Every clinician and therapist treating patients with chronic pain should have a thorough understanding of physical rehabilitation methods in the comprehensive management of pain and related disability. While this task may appear formidable, Lewit’s Manipulative Therapy in Rehabilitation of the Locomotor System, Third Edition, soundly addresses all aspects of functional restoration of the neuromusculoskeletal system, including functional anatomy, radiography, diagnosis of disturbed locomotor system function, and treatment of functional problems. The author stresses the use of gentle yet highly skilled techniques that are comfortable for the patient and that expedite therapeutic outcomes. Some unique contributions that were lacking in the previous edition are included in the third edition, notably in chapters 2, 4, 6, and 7. The author expands the therapeutic techniques and clinical correlation sections and offers more clinical relevance. The illustrations are arranged to follow the text and reinforce the author’s discussions. However, I find that the printing quality of the diagrams in this edition has compromised clarity. Chapter 2 discusses the significance of soft tissues, in particular the connective tissue and fascia, in assessing the locomotor system. The discussion on the art of diagnosing dysfunction and the subsequent explanation of precise soft-tissue treatment adds another dimension to Lewit’s previous concepts of the functional motor system. He has always explained the importance of posture and gain analysis and the awareness of abnormal soft-tissue tensions in the patient. However, here he adds key diagnostic and clinical criteria to help us understand the significance of what we are palpating. Notably, the author also adds a critical point absent in the previous edition: the feet are a transitional area and key determinant of spinal column function. Chapter 4 is a phenomenal representation of the depth of the author’s knowledge on the subject of locomotor system function. This chapter, although not all-inclusive, stimulates clinicians/therapists to expand their current knowledge base. The emphasis of this chapter is to help us find the primary cause of our patient’s problem and then to uncover and treat the relevant findings. For example, we may find our patient
has a tight upper trapezius, a hypotonic gluteus maximus, a hypertonic hamstring, weak abdominal muscles, and fascial restrictions causing abnormal inclinations such as a forward posture or torsioned pelvis. The author attempts to link the clinical data to what he calls “chain reactions.” I find the author’s descriptions of functional pathology principles and the “chains” to be exciting. Chapter 6 adds new techniques and ideas to the repertoire of the second edition. Lewit explores the osteopathic “indirect manipulation” and strain/counterstrain soft-tissue technique. He expands on treatment of the neck and extremities and also mentions treatment of the scalp and periosteal points. In addition, Lewit gives new procedures for treatment of the pectoralis, latissimus dorsi, and other muscles. He discusses how to train the weak abdominal and gluteal muscles and how to correct a patient’s standing posture. He effectively describes the clinical picture of a patient with a particular muscle or soft-tissue dysfunction: this aspect was not addressed sufficiently in the second edition. Chapter 7 integrates many of the concepts given in the previous chapters, primarily by discussing specific clinical entities or syndromes and relating the discussion to particular case studies. The author gives many useful ideas for managing difficult cases and makes some of those same cases appear quite straightforward. I found the discussion on the ‘S’-reflex (Silverstone-Skoglurd), in regard to the evaluation of pelvic dysfunction, as well as the exercises aimed at the pelvic diaphragm, to be of particular interest. Lewit shows that logical and appropriate functional restoration techniques of spinal and extraspinal rehabilitation fall within the core skills and scope of chiropractic practice; he discusses this point in detail in the first chapter. These techniques represent a formal, structured, detailed adjunct to traditional aspects of chiropractic practice. In the preface, Lewit says his purpose “is to show that it can be disastrous to confine one’s interest . . . and to remain unaware of both the broader context of treatment and of the possible alternatives.” After reading this new edition, I have no doubt that Lewit continues to be a pioneer in the field of physical rehabilitation for clinicians and manual therapists alike. Stacy M. Thornhill, DC The National College of Chiropractic 200 E. Roosevelt Road Lombard, IL 60148
495
BOOK REVIEWS
Manipulative Therapy in Rehabilitation of the Locomotor System, Third Edition. Karel Lewit, MD: Butterworth-Heinemann; 1999. 346 pages. Every clinician and therapist treating patients with chronic pain should have a thorough understanding of physical rehabilitation methods in the comprehensive management of pain and related disability. While this task may appear formidable, Lewit’s Manipulative Therapy in Rehabilitation of the Locomotor System, Third Edition, soundly addresses all aspects of functional restoration of the neuromusculoskeletal system, including functional anatomy, radiography, diagnosis of disturbed locomotor system function, and treatment of functional problems. The author stresses the use of gentle yet highly skilled techniques that are comfortable for the patient and that expedite therapeutic outcomes. Some unique contributions that were lacking in the previous edition are included in the third edition, notably in chapters 2, 4, 6, and 7. The author expands the therapeutic techniques and clinical correlation sections and offers more clinical relevance. The illustrations are arranged to follow the text and reinforce the author’s discussions. However, I find that the printing quality of the diagrams in this edition has compromised clarity. Chapter 2 discusses the significance of soft tissues, in particular the connective tissue and fascia, in assessing the locomotor system. The discussion on the art of diagnosing dysfunction and the subsequent explanation of precise soft-tissue treatment adds another dimension to Lewit’s previous concepts of the functional motor system. He has always explained the importance of posture and gain analysis and the awareness of abnormal soft-tissue tensions in the patient. However, here he adds key diagnostic and clinical criteria to help us understand the significance of what we are palpating. Notably, the author also adds a critical point absent in the previous edition: the feet are a transitional area and key determinant of spinal column function. Chapter 4 is a phenomenal representation of the depth of the author’s knowledge on the subject of locomotor system function. This chapter, although not all-inclusive, stimulates clinicians/therapists to expand their current knowledge base. The emphasis of this chapter is to help us find the primary cause of our patient’s problem and then to uncover and treat the relevant findings. For example, we may find our patient
has a tight upper trapezius, a hypotonic gluteus maximus, a hypertonic hamstring, weak abdominal muscles, and fascial restrictions causing abnormal inclinations such as a forward posture or torsioned pelvis. The author attempts to link the clinical data to what he calls “chain reactions.” I find the author’s descriptions of functional pathology principles and the “chains” to be exciting. Chapter 6 adds new techniques and ideas to the repertoire of the second edition. Lewit explores the osteopathic “indirect manipulation” and strain/counterstrain soft-tissue technique. He expands on treatment of the neck and extremities and also mentions treatment of the scalp and periosteal points. In addition, Lewit gives new procedures for treatment of the pectoralis, latissimus dorsi, and other muscles. He discusses how to train the weak abdominal and gluteal muscles and how to correct a patient’s standing posture. He effectively describes the clinical picture of a patient with a particular muscle or soft-tissue dysfunction: this aspect was not addressed sufficiently in the second edition. Chapter 7 integrates many of the concepts given in the previous chapters, primarily by discussing specific clinical entities or syndromes and relating the discussion to particular case studies. The author gives many useful ideas for managing difficult cases and makes some of those same cases appear quite straightforward. I found the discussion on the ‘S’-reflex (Silverstone-Skoglurd), in regard to the evaluation of pelvic dysfunction, as well as the exercises aimed at the pelvic diaphragm, to be of particular interest. Lewit shows that logical and appropriate functional restoration techniques of spinal and extraspinal rehabilitation fall within the core skills and scope of chiropractic practice; he discusses this point in detail in the first chapter. These techniques represent a formal, structured, detailed adjunct to traditional aspects of chiropractic practice. In the preface, Lewit says his purpose “is to show that it can be disastrous to confine one’s interest . . . and to remain unaware of both the broader context of treatment and of the possible alternatives.” After reading this new edition, I have no doubt that Lewit continues to be a pioneer in the field of physical rehabilitation for clinicians and manual therapists alike. Stacy M. Thornhill, DC The National College of Chiropractic 200 E. Roosevelt Road Lombard, IL 60148
495